糖尿病合并脑梗死患者急性期血清IL-18、MMP-7和MMP-8水平的变化及阿托伐他汀调脂治疗的干预作用

The changes of serum interleukin-18,marix metalloproteinases-7 and marix metalloproteinases-8 in patients of type 2 diabetes mellitus with acute cerebral infarction and the effect of atorvastatin lipid-lowering treatment

目的观察糖尿病合并脑梗死患者急性期血清炎性因子白细胞介素-18(IL-18)、基质金属蛋白酶-7(MMP-7)及基质金属蛋白酶-8(MMP-8)水平的变化和临床意义,探讨不同剂量阿托伐他汀调脂治疗对脑梗死炎症抑制和颈动脉斑块稳定性的作用。方法 120例糖尿病合并脑梗死患者根据颈动脉超声检查结果分为颈动脉稳定斑块组(n=60)和颈动脉易损斑块组(n=60),抽血检查后分别随机分为小剂量组30例(阿托伐他汀10 mg/d,口服)和大剂量组30例(阿托伐他汀40 mg/d,口服)。比较治疗前和治疗后4周血清IL-18、MMP-7和MMP-8水平的变化。结果治疗前,同种性质斑块组中两亚组间(大、小剂量组)血清IL-18、MMP-7和MMP-8水平差异均无统计学意义(均P>0.05),两种性质斑块间比较,易损斑块组中亚组无论是小剂量组或大剂量组血清IL-18、MMP-7和MMP-8水平均高于稳定斑块组(均P<0.01)。治疗后4周,同一性质斑块组中亚组(大、小剂量组)血清IL-18、MMP-7和MMP-8水平均下降,但大剂量组三项指标下降幅度均大于小剂量组(均P<0.01)。结论血清IL-18、MMP-7和MMP-8水平均可能作为糖尿病合并脑梗死患者颈动脉易损斑块检测的生物学指标,大剂量阿托伐他汀调脂治疗能迅速降低患者血清炎性因子水平,在一定程度上可提高易损斑块的稳定性。

Objective To observe the changes and clinical signifance of inflammatory factors such as interleukin-18 （IL- 18）, marix metalloproteinase-7 （MMP-7） and marix metalloproteinase-8 （MMP-8） in patients of type 2 diabetes mellitus with acute cerebral infarction （ACI） and to explore the effects of different doses of atorvastatin lipid-lowering treatment on inhibiting inflammation and stabilizing the carotid artery plaque. Methods According to the results of carotid artery ultra- sound, 120 cases of patients of type 2 diabetes mellitus with AC1 were divided into carotid vulnerable plaque group and carotid stable plaque group in each of which had 60 cases. Both randomly selected 30 cases were given a small dose （low- dose group） and high dose atorvastatin （high-dose group） treatment. Patients in low-dose group received atorvastatin 10 mg daily, whereas patients in high-dose group received atorvastatin 40 mg daily. Levels of serum IL-18, MMP-7 and MMP-8 were detected in all patients before treatment and four-weeks after drug therapy. Results Before treatment, there were no significant differences on levels of IL-18, MMP-7 and MMP-8 in patients of Type 2 Diabetes Mellitus with the same carotid plaques between low-dose group and high-dose group （all P 〉 0.05）. No matter what treatment accepted, levels of IL-18, MMP-7 and MMP-8 were obviously higher in patients with unstable plaques than those with stable plaques （all P 〈 0.01）. Compared with the treatment before, levels of IL-18, MMP-7 and MMP-8 were significantly decreased in patients who treated with high-dose atorvastatin for 4 weeks, as well as in patients who treated with low-dose atorvastatin （all P 〈 0.01）. Four weeks later, the decrease of levels of of IL-18, MMP-7 and MMP-8 were obviously higher in high-dose group than in low-dose group （all P 〈 0.01）. Conclusion The present findings suggest that serum IL-18, MMP-7 and MMP-8 levels may be the biomarkers in patients of Type 2 Diabetes Mellitus with ACI for carotid vulnerable plaque. High-dose atorvastatin can rapidly reduce serum inflammatory factors, to a certain extent, might stabilize the atherusclerosis plaque.